Basic Information
| Provider Information | |||||||||
| NPI: | 1093063034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SENIOR LINK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 WESLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135315110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4750 WESLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135315110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2012 | ||||||||
| LastUpdateDate: | 08/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | PEENO | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | RN | ||||||||
| AuthorizedOfficialTelephone: | 5135315110 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0600X | RN 339599 | OH | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care |
No ID Information.